Obesity and Weight-Loss Quality-of-Life Questionnaire


  1. This questionnaire is an important part of your overall medical evaluation. The questions are designed to collect information about how your health has affected your quality of life from your own point of view.
  2. Please take the time to read and answer each question carefully. Some questions may look like others, but each one is different.
  3. Please answer every question by choosing the option that best describes your answer.
  4. There are no right or wrong answers. If you are unsure about how to answer a question, please give the best answer you can.
  5. Your answers are confidential. The study coordinators will check for completeness only and not share your answer with other clinical staff.

Your Feelings About Your Weight

Below is a list of statements about your quality of life in relation to being overweight and trying to lose weight.

For each of the following statements, please check the box that best describes your answer at this time.

0 = Not all, 1 = Hardly, 2 = Somewhat, 3 = Moderately, 4 = A good deal, 5 = A great deal, and 6 = A very great deal